Utility of Smartphone Telemedical Consultations for Peritonsillar Abscess Diagnosis and Triage.

Importance: Telemedicine is rapidly gaining traction as a way to reduce costs and connect patients with medical experts outside their local communities. Peritonsillar abscess (PTA) is a logical pathologic condition to evaluate for effectiveness of remote diagnosis given its prevalence and the paucity of on-site otolaryngologists at many institutions. Objective: To explore the potential of otolaryngology telemedical consultation in triaging and diagnosing patients with suspected PTA. Design, Setting, and Participants: A comparative effectiveness research study was conducted from January 1 to June 30, 2018, at 3 tertiary care hospitals among 31 consecutive patients aged 18 to 85 years for whom the otolaryngology department was consulted to assess for PTA. Statistical analysis was conducted from July 1 to September 30, 2018. Interventions: Telemedical evaluation of suspected PTA by 5 attending otolaryngologists blinded to patients' history aside from the chief report of odynophagia. Otolaryngologists rated each patient video on whether they believed the patient had a PTA and whether the case warranted prompt evaluation by an otolaryngologist. Predictions were compared with the criterion standard of drainage or negative needle aspiration. Otolaryngologists additionally assessed video quality. Main Outcomes and Measures: Rates of accurate diagnosis and triage of PTA based on otolaryngologists' review of oropharyngeal examinations recorded using standard smartphone cameras, as well as percentage of videos of oropharyngeal examinations using standard smartphone cameras deemed of sufficiently high quality for clinical decision-making. Results: A total of 31 patients (16 women [51.6%]; mean age, 31.9 years [range, 18-62 years]) were recruited, and 16 patients (51.6%) had a PTA. Comparing otolaryngologists' predictions with PTA status by the criterion standard, the prediction was consistent with that of the criterion standard 81% of the time averaged across otolaryngologists (mean diagnostic accuracy, 0.81). Similarly, the mean diagnostic accuracy was 0.83 when comparing the otolaryngologist's suggestion for a prompt in-person evaluation with actual PTA status by the criterion standard. Comparing patients who were deemed to require prompt otolaryngology evaluation and those with PTA by the criterion standard, mean sensitivity was 90%. Videos were rated as of sufficiently high quality to make a diagnosis in 154 of 155 videos (99.4%). Conclusions and Relevance: This study suggests that telemedical consultation is a viable, cost-conscious, efficient, and safe approach to PTA management. Despite having some difficulty diagnosing PTAs based on "history concerning for PTA" and oropharyngeal video alone, otolaryngologists are able to determine, with high sensitivity, which patients require prompt otolaryngology evaluation. The recording of consistently high-quality video using a standard smartphone camera is achievable without formal training.

The effect of low predicted/calculated postoperative keratometry on corrected distance visual acuity after LASIK.

PURPOSE: To compare refractive outcomes of eyes with flat keratometry (K) to matched controls after myopic laser in situ keratomileusis (LASIK). SETTING: Boston Eye Group, Brookline, Massachusetts, USA. DESIGN: Retrospective review. METHODS: Eyes that had LASIK between December 2008 and December 2018 were retrospectively analyzed and matched based on calculated postoperative flat K values. Stratified candidate subgroups (K < 38.0 diopters [D]) were compared with control subgroups (K ≥ 38.0 D). RESULTS: The study comprised 160 eyes (80 candidates and 80 controls). Statistical analyses showed no significant differences between candidates and controls in preoperative corrected distance visual acuity (CDVA) (P = .150) or postoperative CDVA (P = .290). There were no significant differences in the amount of tissue ablated between all candidate and control subgroups. Similarly, there was no significant change between preoperative and postoperative CDVA between the different candidate and respective subgroups. Three (3.75%) of 80 candidate eyes versus zero control eyes lost 1+ lines of CDVA after surgery. There was no difference in CDVA lost between these groups (P = .2453). CONCLUSION: There is no increased risk for loss of CDVA after LASIK attributable to flat K.

Lyotropic liquid crystals formed from ACHC-rich ß-peptides.

We have examined the effect of ß-peptide modifications on the propensity of these helical molecules to form lyotropic liquid crystalline (LC) phases in water. All of the ß-peptides we have examined contain 10 residues. In each case, at least three residues are derived from trans-2-aminocyclohexanecarboxylic acid (ACHC), which strongly promotes folding to a 14-helical conformation. The structural features varied include the number of ACHC residues, the nature and spatial arrangement of charged side chains (cationic vs anionic), and the identity of groups at the ß-peptide termini. We found that relatively small changes (e.g., swapping the positions of a cationic and an anionic side chain) could have large effects, such as abrogation of LC phase formation. The trends revealed by sequence-property studies led to the design of LC-forming ß-peptides that bear biomolecular recognition groups (biotin or the tripeptide Arg-Gly-Asp). Structural analysis via circular dichroism and cryo-transmission electron microscopy revealed the existence of two different types of self-associated species, globular aggregates and nanofibers. Nanofibers are the predominant assembly formed at concentrations that lead to LC phase formation, and we conclude that these nanofibers are the functional mesogens. Overall, these studies show how the modularity of ß-peptide oligomers enables elucidation of the relationship between molecular structure and large-scale self-assembly behavior.